Self Efficacy Middle Range Theory in Nursing Care

Nursing Care and Self Efficacy Theory 

Self-Efficacy Middle Range Theory,Contribution of Bandura, Sources of Judgement about Self Efficacy,Nursing Research Contribution,Self Efficacy Theory Implementation.

Self-Efficacy Middle Range Theory

    The theory of self-efficacy, which was originally developed by Bandura (1977), is based on social cognitive theory. The theory conceptualizes person behavior environment interaction as triadic reciprocally, the foundation for reciprocal determinism.

    Triadic reciprocally is the interrelationship among person, behavior and environ ment; reciprocal determinism is the belief that behavior, cognitive and other personal factors and environmental influences all operate interactively as determinants of each other. (Resnick, 2003, p. 49)

Contribution of Bandura

    Early work by Bandura and colleagues attempted manipulation of the level and strength of an individual's self-efficacy to effect behavioral change (Resnick). 

    Self-efficacy theory is at the middle range of abstraction, appealing to nurses who are interested in a conceptual structure which will guide practice and research focused on behavioral change. 

    To say the theory is at the middle range means that it is more complex than simple hypotheses and yet targeted enough to be applicable. Self-efficacy is defined as "an individual's judgment of his or her capabilities to organize and execute courses of action" (Resnick). 

    The major concepts of self- efficacy theory are self-efficacy expectations and outcome expectations. Resnick describes self-efficacy expectations as judgments about one's own ability to accomplish a particular task; outcome expectations are judgments about what will transpire if a particular task is successfully accomplished. 

    "Self-efficacy and outcome expectations were differentiated because individuals can believe that a certain behavior will result in a specific out- come; however, they may not believe that they are capable of performing the behavior required for the outcome to occur" (Resnick, p. 51). 

    For instance, a smoker might believe that her frequent bouts of bronchitis would diminish if she would stop smoking; however, she may not believe that she is able to stop. In this instance, expected outcomes are dependent on self-efficacy judgments. Resnick also describes times when outcome expectations are dissociated from self efficacy expectations (behavior change is loosely linked or not linked to outcomes). 

    For example, dissociated expectations would occur if the smoker previously discussed believed that her bronchitis was related to the geographic area where she lived. In this instance, smoking is not firmly linked to bronchitis symptoms in the mind of the smoker, influencing likelihood of attempting behavior change.

Sources of Judgement about Self Efficacy

    Resnick (2003) discusses four information sources which influence judgment about one's self-efficacy: 

(1) enactive attainment- actual performance of the desired behavior

(2) vicarious experience-watching others who are similar to self-perform the desired behavior

(3) verbal persuasion encouragement by others, noting the individual's capability for performing the desired behavior

(4) physiological feedback-bodily experience while performing the desired behavior. 

    Each of these information sources becomes an avenue for nursing intervention to affect behavior change in practice or to study behavior change in research. In addition to information sources which may influence self-efficacy, experience interacts with individual characteristics and environment to affect self-efficacy and outcome expectations.

Nursing Research Contribution

    Resnick (2003) reports that within the decade more than 400 articles in nursing journals incorporate self-efficacy theory when addressing behavior change. 

    These articles cover a broad range of topics including the education of nurses and parental training, but the majority of these articles have been related to chronic health problems and participation in health promoting activities, such as exercise, smoking cessation, and weight loss. 

    Resnick herself has used self-efficacy theory to develop interventions such as the WALC (Walk, address unpleasant symptoms, learn about exercise, cueing to exercise) intervention, the Exercise Plus Program, and the Seven Step Approach to Developing and Implementing an Exercise Program. 

    She has used the theory to guide research intended to influence elders' participation in functional activities and exercise (Resnick). When measuring self-efficacy, scale items query respondents' confidence (0 = not confident; 10 = very confident) regarding specific factors that might affect behavior change. 

    "The development of appropriate self-efficacy and out- come expectation measures enables the testing of interventions designed to help participants believe in the benefits and overcome the challenges of performing selected activities" (Resnick, p. 60).

Self Efficacy Theory Implementation

    In less than 30 years since Bandura introduced self-efficacy theory, it has been widely used by professionals from many disciplines. Its usefulness for nursing stems from its relevance for health promotion through behavioral change. 

    The theory could offer valuable guidance for undergraduate and graduate students who wish to teach patients about changing health behaviors; it would provide an evidence based framework for selecting potentially effective teaching strategies. 

    Selfefficacy is a mature middle range theory, which has been tested through research and has demonstrated application for practice. 

    Since most of the research on the theory has focused on self efficacy expectations (Res- nick, 2003), there continues to be a need for studying outcome expectations and the relationship between self efficacy and outcome expectations. 

    Nursing is well positioned to lead the way with continuing development of this middle-range theory to promote further understanding of factors influencing health promoting behavior change.